RJ 
486 

B24 


BARKER 

PRINCIPLES  OF 
MENTAL  HYGIENE 
APPLED  TO  THE 
MANAGEMENT  OF 
CHILDREN 
PREDISPOSED  TO 
NERVOUSNESS 


THE  LIBRARY 

OF 
THE  UNIVERSITY 

OF  CALIFORNIA 
LOS  ANGELES 


Principles  of  Mental  Hygiene  applied 

to  the  Management  of  Children 

predisposed  to  Nervousness. 


By  DR.  LEWELLYS  F.  BARKER 
Professor  of  Medicine,  Johns  Hopkins  University 


Published  by 

THE  NATIONAL  COMMITTEE  FOR  MENTAL  HYGIENE 
50  Union  Square,  New  York  City 

373  2, 


Publication  No.  2 


The  National  Committee  for  Mental  Hygiene 

50  UNION  SQUARE,  NEW  YORK  CITY 


President 

DR.  LEWELLYS  F.  BARKER 

Treasurer  Vice-Presidents  Secretary 

MR.  OTTO  T.  BANNARD  DR.  WILLIAM  H.  WELCH  MR.  CLIFFORD  W.  BEERS 

DR.  CHARLES  P.  BANCROFT 

DR.  GEORGE  BLUMER.  Chairman.  Executive  Comr 
PROF.  RUSSELL  H.  CHITTENDEN.  Chairman.  Finance  Committee 
DR.  WILLIAM  L.  RUSSELL  Chairman.  Committee  for  Special  Studies 
DR.  THOMAS  W.  SALMON.  In  charge  of  Special  Studies 

MEMBERS 

HARRY  PRATT  TUDSON,  Chicago 

York 

Conn. 
York 

. 

:•  R,   Albany 
:nneapolis 
ton 
Cambridge 

,'ork 

ijton 

York 
i'ork 

DR.  White  Plains.  K 

HURMAN,  Ithaca 
-  f  ARR,  New  York 

KS,  JR.,  New  Haven 

nrk  New  York 

,   Nordhoff,   Cal. 

:ore 

ambridge 

rkeley,  Cal. 

.ew  York 
Cal. 

The  Chief   Object*  of  the  National  Committee  for   Mental  Hygiene  are : 

To  work  for  the  protection  of  the  mental  health  of  the  public :  to  help  raise  the  stan- 
dard of  care  for  those  threatened  with  mental  disorder  or  actually  ill;  to  promote  the  study 
of  mental  disorders  in  all  their  forms  and  relations  and  to  disseminate  knowledge  concern- 
ing their  causes,  treatment  and  prevention;  to  obtain  from  every  source  reliable  data  regard- 
ing conditions  and  methods  of  dealing  with  mental  disorders ;  to  enlist  the  aid  of  the  Fed- 
eral  Government  so  far  as  may  seem  desirable;  to  co-ordinate  existing  agencies  and  help 
organize  in  each  State  in  the  Union  an  allied,  but  independent  Society  for  Mental  Hygiene, 
similar  to  the  existing  Connecticut  Society  for  Mental  Hygiene. 

Inquiries  regarding  the  work  and  requests  for  pamphlets  issued  by 
the  organization  should  be  addressed  to  Clifford  W.  Beers,  Secretary, 
The  National  Committee  for  Mental  Hygiene,  Room  1914,  No.  50 
Union  Square,  New  York  City,  or  to  Dr.  Thomas  W.  Salmon  at  the 
same  address. 


PRINCIPLES  OF  MENTAL  HYGIENE  APPLIED 

TO  THE  MANAGEMENT  OF  CHILDREN 

PREDISPOSED  TO  NERVOUSNESS. 

BY  LEWELLYS  F.  BARKER,  M.D. 
Professor  of  Medicine,  Johns  Hopkins  University. 

Whether  a  person  becomes  nervous  or  not  depends  upon  two 
great  factors  (a)  the  constitution  which  he  inherits  from  his 
parents  and  through  them  from  his  ancestors  generally;  (b)  the 
influences  to  which  his  body,  especially  his  nervous  system,  is 
exposed  during  life  and  particularly  during  childhood.  There 
will  always  be  differences  of  opinion  among  serious  students  of 
the  subject  as  to  the  relative  importance  of  these  two  factors; 
some  assume  that  heredity  or  nature  is  the  all  important  factor; 
others  maintain  that  this  is  relatively  insignificant  and  that  en- 
vironment or  nurture  accounts  for  everything;  both  views  are 
one  sided.  Both  nature  and  nurture  are  of  fundamental  import- 
ance and  only  by  considering  the  two  aspects  of  the  subject  fairly 
can  sound  ideas  ever  be  arrived  at. 

Heredity  and  environment  overlap  in  one  period  of  life ;  during 
early  childhood  the  individual  is  usually  under  the  educational 
influence  of  his  parents  and  exposed  to  their  example.  Doubtless 
much  that  is  sometimes  attributed  to  direct  inheritance  is  really 
due  to  the  influence  after  birth,  of  imitation  of  the  parents.  Where 
the  heredity  is  notoriously  bad  it  might  be  well,  as  Oppenheim  ( I ) 
suggests,  to  protect  children,  who  have  the  ill  fortune  to  be  born  \ 
under  such  conditions,  from  the  dangers  of  psychic  infection  in  , 
the  parental  environment;  such  children  taken  away  from  home 
and  placed  under  more  favorable  conditions  would  have  a  better 
chance  of  counteracting  the  faults  of  inheritance. 

In  families  in  which  nervous  states  prevail  it  is  a  matter  of 
great  interest  to  know  in  how  far  the  nervous  tendency  can  be 

Read  at  Baltimore,  February  10,  1911,  before  the  Public  Health  Conference  of  the  Medical 
and  Chirurgical  Faculty  of  Maryland. 


2  MENTAL  HYGIENE 

overcome  by  educational  means  and  especially  to  learn  what  to 
avoid  because  of  its  likelihood  to  injure  the  nervous  system._Eyen 
in  families  in  which  no  nervous  taints  exist  in  the  parents  or  near 


relatives  the  children  sometimes  become  nervous  through  faulty 
education  and  there,  is  a  growing  desire  on  the  part  of  well 
informed  people  now-a-days  to  make  sure  that  the  means  of 
education  they  provide  for  their  children  shall  be  such  that  the 
nervous  system  will  be  protected  and  strengthened  rather  than 
exposed  to  over-strain  and  injury. 

One  fact  which  has  become  ever  clearer  as  medical  knowledge 
has  advanced  concerns  the  nutrition  of_the ..child.  Faulty  feeding 
in  infancy  and  early  childhood  may  lead  to  such  impoverishment 
of  the  tissues  and  such  stunting  of  growth  that  the  ill  effects  can 
never  be  recovered  from  in  later  life.  A  considerable  proportion 
of  the  intellectual  and  moral  inferiorities  among  our  people  is 
fairly  attributable  to  imperfect  nutrition  at  this  early  age.  For- 
tunately the  public  is  now  being  so  thoroughly  educated  to  the 
importance  of  breast  feeding  for  infants  and  of  liberal  and  suit- 
able diet  during  the  early  years  of  life,  by  family  physicians  and 
also  through  the  excellent  little  manuals  of  Holt  (2),  Starr  (3), 
Griffith  (4)  and  others  on  the  care  and  feeding  of  children  that 
it  is  not  necessary  to  dwell  at  length  upon  the  subject.  Plenty  of 
good  simple  food,  including  milk,  meat,  vegetables  and  fruit,  with 
avoidance  of  condiments,  coffee,  tea  and  alcohol  is  approved  by 
all  authorities. 

Many  parents  make  the  mistake  of  allowing  the  caprice  of  the 
child  to  influence  its  diet.  We  now  know  the  foods  that  are 
suitable  for  children  and,  knowing  these,  the  children  should  be 
provided  with  them  in  suitable  amounts  and  should  be  required 
to  eat  of  them,  largely  independent  of  choice.  The  child  that 
learns  to  eat  and  digest  all  wholesome  foods  and  who  is  not  per- 
mitted to  cultivate  little  food  antipathies  makes  a  good  start  and 
avoids  one  of  the  worst  pit-falls  of  life  with  which  medical  men 
are  very  familiar,  namely  a  finical  anxiety  concerning  the 
effects  of  various  foods,  all  too  likely  to  develop  into  a  hypochon- 
driacal  state. 

There  is  a  greater  recognition  now  than  formerly,  also,  of  the 


MENTAL  HYGIENE  3 

fact  that  children  should  not  be  too  tenderly  brought  up — that  a 
certain  amount  of  judicious  hardening  of  the  body  is  desirable. 
While  faddists  and  extremists  in  this  direction  fall  into  grievous 
errors,  making  their  children  go  barefoot  and  barelegged  in  the 
snow  and  compelling  the  feeble,  non-reacting  child  to  take  plunges 
in  ice  cold  water,  a  still  greater  mistake  is  made  by  those  who 
over-protect  their  children  and  who  fail  to  accustom  their  bodies 
early  to  cool  baths  and  to  exercise  in  all  sorts  of  weather. 

The  child  who  is  brought  up  in  such  a  way  that  he  is  very 
sensitive  to  slight  changes  in  temperature  is  bound  to  suffer  from 
it  sooner  or  later  and  everyone  is  familiar  with  those  who  grumble 
at  the  weather.  If  children  be  suitably  dressed  and  are  early 
accustomed  to  taking  a  cool  bath  in  the  morning  and  to  walks 
out-of-doors  every  day,  rain  or  shine  and  whether  it  be  cold  or 
warm,  the  skin  and  nervous  system  quickly  acquire  a  tolerance 
for  variations  in  temperature  most  desirable  for  health  and  for 
the  feeling  of  well-being. 

An  out-of-door  life  for  children  also  leads  them  unconsciously 
to  exercise  their  muscles  more  than  is  possible  for  the  child  who 
stays  in-doors.  Not  only  physicians  but  also  laymen  from  the  old 
Greek  times  to  the  present  have  been  impressed  with  the  import- 
ance of  bodily  exercise  and  harmonious  muscular  development 
for  the  welfare  of  the  mind  and  of  the  nervous  system.  If  we 
wish  our  children  to  be  strong,  energetic  and  courageous,  if  we 
desire  to  insure  them  against  the  nervous  ills  which  follow  in  the 
wake  of  debility,  inertia  and  timidity,  we  must  see  to  it  that  all 
the  muscles  of  their  bodies  are  systematically  and  regularly  exer- 
cised. For  this  purpose  the  plays  of  children  are  very  important 
and  the  only  child,  deprived  of  the  companionship  of  brothers  and 
sisters,  unless  pains  are  taken  to  supply  other  playmates  for  him, 
is  much  to  be  pitied.  Besides  play,  walking,  running,  rowing, 
riding,  swimming,  paddling  and  sailing  are  all  desirable  forms  of 
bodily  exercise.  In  cities,  and  especially  during  the  school  year, 
i  systematic  gymnastic  exercises,  calisthenics,  have  to  be  resorted 
to  and  where  no  suitable  gymnastic  exercises  can  be  obtained, 
parents  will  do  well  to  teach  older  children  some  forms  of  exer- 
cises to  be  taken  in  the  early  morning.  One  of  the  best  of  the 


4  MENTAL  HYGIENE 

various  systems  worked  out  is  that  of  a  Dane,  one  J.  P.  Miiller  (5) 
who  in  his  little  book  My  System  outlines  a  series  of  exercises 
which  anyone  may  carry  out  in  his  own  room  without  apparatus. 
These  exercises  are  physiologically  well  devised  and  I  can  recom- 
mend them  heartily,  not  only  for  older  children  but  also  for  both 
men  and  women  who  have  to  compress  the  exercises  of  the  day 
into  a  very  short  period.  The  exercises  recommended  in  this 
country  by  Luther  Gulick  (6),  by  Tait  MacKenzie  (7)  and  others 
may  also  be  mentioned.  I  would  call  your  attention  also  to  the 
works  of  Lagrange  (8). 

An  anxious  mother  will  often  ask  to  have  her  nervous  child 
excused  from  regular  exercises  at  school.  This  is  usually  a 
mistake,  for  nervous  children  even  more  than  normal  children, 
require  systematic  muscular  exercises.  It  should,  of  course,  be 
properly  regulated  and  where  there  is  any  doubt  as  to  the 
reliability  of  the  supervision  of  such  work  at  a  school  gymnasium, 
definite  instructions  should  be  obtained  from  the  family  physician 
as  to  the  character  and  amount  of  exercises  to  be  undertaken. 

While  emphasis  is  thus  laid  upon  suitable  bodily  exercise  for 
children  predisposed  to  nervousness  a  warning  should  be  sounded 
against  jjxcesses  in  sports  like  tennis,  foot-ball,  basket-ball  and 
other  games  in  which  there  is  opportunity  for  competition  or 
rivalry.  Over-ambition  in  these  directions  is  often  most  harmful 
both  to  the  body  and  to  the  mind  of  the  child  and  should  be 
especially  avoided  where  there  is  any  neuropathic  taint. 

>In  addition  to  the  hardening  of  the  body,  the  education  of  the 
child  should  include  measures  which  increase  the  resistance  of 
the  child  against  pain  and  discomforts  of  various  sorts.  Every 
child,  therefore,  should  undergo  a  gradual  process  of  "psychicj 
hardening"  and  be  taught  to  bear  with  equanimity  the  pain  and 
discomfort  to  which  everyone  sooner  or  later  cannot  help  but  be 
exposed.  What  I  have  said  about  clothing,  cold  baths,  walking 
in  all  weather  and  at  all  temperatures,  play  and  exercise  in  the 
open  air,  has  a  bearing  on  this  point,  for  a  child  who  has  formed 
good  habits  in  these  various  directions  will  have  learned  many 
lessons  in  the  steeling  of  his  mind  to  bear  pain  and  to  ignore  small 
discomforts. 


MENTAL  HYGIENE  5 

Physicians  who  work  among  nervous  cases  realize  how  often 
the  child  who  has  been  too  much  protected  from  pain  becomes  the 
victim  of  nervous  break-down  later  in  life.  I  have  seen  many  a 
woman  who  could  bear  great  sorrow  or  suffer  without  flinching 
the  pain  of  childbirth  who  still  had  no  tolerance  for  the  little  ills 
of  life.  In  such  cases  it  is  the  idea  rather  than  the  sensation  from 
which  the  patient  suffers  and  such  abnormal  ideas  most  frequently 
arise  in  those  who  have  not  learned  in  childhood  to  bear  pain  well 
or  to  adjust  themselves  without  complaint  to  the  disagreeable 
sensations  and  experiences  which  are  essential  to  a  normal  bring- 
ing up. 

The  boy  who  learns  to  tumble  in  a  gymnasium,  to  stand  the 
pain  of  boxing  and  fencing  and  wrestling  and  to  keep  his  temper 
while  engaging  in  these  exercises  will  have  subjected  himself  to 
a  training  which  cannot  help  but  stand  him  in  good  stead  later 
on  in  life.  One  reason  why  women  are  more  prone  in  later  life 
to  nervousness  than  men  may  lie  in  the  lessened  opportunity 
which  girls  have  for  bodily  and  psychic  hardening  in  the  games 
which  they  play  and  the  life  which  they  lead  as  children.  Par- 
ticular care  should  be  taken  with  young  girls  who  show  any  ten- 
dency to  nervousness  to  .see  to  it  that  not  too  much  concession  is 
made  to  their  likes  and  dislikes.  Nothing  can  be  more  harmful 
to  them  than  the  gratification  of  caprice.  Especially  when  a  child, 
shows  a  tendency  to  be  nauseated  by  certain  smells  and  tastes  and ' 
to  complain  of  noises  or  of  sensitiveness  to  bright  light  ,the  family 
physician  should  be  consulted  and,  provided  no  actual  disease  of 
the  sense  organs  or  brain  is  responsible,  the  process  of  psychic 
hardening  should  at  once  be  begun. 

Neglected,  it  is  surprising  to  what  vagaries  such  hypersensitive- 
ness  may  lead.  A  lady  recently  consulted  me  on  account  of  a 
most  distressing  state,  asking  that  "in  the  name  of  mercy  and 
pity"  she  should  be  given  some  help  and  told  how  to  overcome  an 
obsession  which  distressed  her.  The  sound  of  her  husband  chew- 
ing at  table  completely  upset  her  and  when  he  smoked,  the 
noise  made  by  the  puffing  of  the  smoke  was  torture  to  her;  the 
creaking  of  her  mother's  shoes  as  she  walked  about  the  house 
made  her  most  uncomfortable  during  a  period  of  several  months. 


6  MENTAL  HYGIENE 

Obviously  the  abnormal  idea  in  such  a  case  caused  the  suffering, 
not  the  sensory  impulse  itself. 

Another  patient,  a  gentleman,  who  has  had  repeated  nervous 
break-downs,  told  me  that  they  always  begin  in  the  same  way. 
After  a  night  of  insomnia  he  will  suddenly  become  unable  to  bear 
a  strong  light  and  in  lamp  light  he  complains  that  he  has  a  sensa- 
tion of  pressure  in  the  head  and  an  inability  to  relax  his  limbs. 
He  feels  at  such  times  as  though  he  will  lose  his  mind  and  that  he 
must  have  some  relief  or  he  will  have  to  end  his  life.  In  one  of 
these  attacks  in  early  life,  he  stayed  two  years  in  a  dark  room 
and  only  at  the  end  of  that  time  would  consent  to  remain  in  the 
light.  Obviously  here,  too,  it  was  not  the  sensation  of  light  but 
the  idea  that  the  light  would  injure  him  which  was  the  kernel  of 
his  condition. 

Examples  like  the  two  just  mentioned  could  easily  be  multiplied 
but  they  will  be  sufficient  to  indicate  the  direction  in  which  the 
psychopathic  nervous  system  may  easily  tend.  While  in  severe 
cases  like  these  just  referred  to  the  patients  undoubtedly  started 
out  in  life  with  abnormal  nervous  systems,  it  is  quite  conceivable 
that  a  judicious  hardening  in  early  life  might  have  prevented  the 
later  shipwreck.  I  cannot  too  strongly  recommend,  therefore,  the 
acquisition  of  tolerance  of  disagreeable  feeling-tones  as  early  as 
practicable  in  life. 

/     If  children  can  be  brought  to  behave  normally  in  the  presence 
/  of   the   disagreeable   feeling-tones   just   discussed,   the   task   of 

•      W^      •  "'     '  *° -•        .        •«.-  "  4  • 

educating  them  to  control  themselves  in  circumstances  which  tend 
fxto  arouse  the  stronger  feelings,  emotions  and  passions  will  be 
made  much  easier.    Parents  and  nurses  are  too  little  aw'are  of  the 
/   dangers  of  allowing  the  emotions  or  passions  to  go  unbridled.    The 
/     problem  should  be  recognized  and  attempts  at  the  beginning  of 
its  solution  should  be  made  in  early  infancy.    If  a  young  infant 
be  kept  in  a  normal  routine,  despite  any  emotional  outbreak 
which  it  may  manifest,  an  excellent  start  in  the  training  of  the 
emotions  will  have  been  made.    If  a  child  learns,  that,  by  crying 
or  by  an  exhibitiojn  of  temper,  it  can  gain  the  thing  which  it 
thinks  desirable,  otherwise  unattainable,  a  very  bad  start  will 
have  been  made.    Children  should  early  be  given  to  understand 


MENTAL  HYGIENE  7 

that  they  must  control  themselves  before  their  desires  will  be 
gratified.  How  often  has  an  indulgent  mother  given  a  child 
something  it  has  asked  for  in  order  to  stop  its  crying  and  to  avoid 
a  scene!  It  is  hard  to  imagine  anything,  in  the  circumstances, 
worse  for  the  child.  If,  instead,  the  mother  had  ignored  the 
temper  and  told  the  child  that  it  must  say  "please"  and  must  wait 
a  few  moments  after  its  temper  has  been  controlled  and  the 
request  has  been  made  before  the  desire  will  be  gratified,  it  would 
have  been  quickly  possible  to  convince  the  child  that  it  can  get 
things  by  controlling  itself  rather  than  by  emotional  explosions. 
The  substitution  of  self  mastery  for  emotional  outbreaks  is  easy 
/  when  begun  early  but  very  difficult,  indeed,  well  nigh  impossible, 
if  begun  late  in  life. 

Another  mental  attitude  that  bears  watching  is  the  craving  of., 
the  child_for  sympathy.    Parents  are  really  unkind  in  yielding  too 
much  to  such  a  craving.     True  kindness  will  teach  the  child  to 
rely  more  upon  self-help. 

Still  another  manifestation,  common  in  children  and  fostered 
too  often  by  the  example  of  the  parents,  is  vacillation.  In  one 
form  of  functional  nervous  disease  indecision  is  a  most  prominent 
~  symptom.  Parents  should  see  to  it  that  children  are  not  exposed 
to  a  pernicious  example  in  this  regard.  While  there  are  some 
children  of  the  "hair-trigger"  type  who  have  to  be  taught  delib- 
eration in  the  making  of-  decisions,  there  are  more  who  have~a. 
tendency  to  doubt  and  indecision  and  who  should  be  taught  that 
it  is  better,  after  due  consideration,  to  make  a  decision,  even 
though  it  be  wrong,  and  to  stick  to  it,  rather  than  to  remain  un- 
decided. 

The  extent  to  which  the  fallacy  of  indecision  may  be  carried  is 
well  manifested  by  some  of  the  psychasthenic  patients  who  apply 
to  physicians  for  aid.  Their  indecision  is  often  shown  by  the  wa^ 
in  which  they  make  an  appointment  with  the  physician,  making 
and  breaking  it  several  times  or  changing  the  hour  repeatedly 
before  finally  appearing  in  his  office.  One  of  these  patients  told 
me  that  it  sometimes  took  him  hours  to  decide  what  clothes  to  put 
on  for  the  day.  Fortunately  such  pathological  cases  are  uncom- 
mon but  there  is  every  gradation  from  the  milder  symptoms  of 


8  MENTAL  HYGIENE 

vacillation  to  the  outspoken  and  distressing  indecision  of  the  con- 
firmed psychasthenic.  The  old  motto  "When  in  doubt,  act," 
should  be  kept  in  mind  by  parents  who  note  a  tendency  to  inde- 
cision in  a  child. 

The  control  of  the  stronger  passions  is  for  some  easier  than 
the  mastery  of  ordinary  irritation,  and  nervous  children  should, 
both  by  example  and  by  precept,  be  taught  how  to  stifle  irritability 
whenever  it  arises.  So  few  adults  have  learned  how  to  meet  the 
daily  friction  that  there  would  seem  but  little  chance  as  yet  for 
the  nervous  child  constantly  exposed  to  a  bad  example.  As  an 
observant  writer  has  said,  "an  important  feature  of  the  art  of 
living  consists  in  keeping  the  peace,  the  whole  peace  and  nothing 
but  the  peace  with  those  with  whom  one  is  thrown." 

If  parents  are  prone,  in  their  daily  lives  and  especially  within 
hearing  of  children,  to  blame  the  people  who  surround  them  or 
the  people  about  whom  they  talk,  they  may  often,  quite  uncon- 
sciously, sow  the  seeds  of  malevolence  in  young  minds.  Just  as 
cheerfulness  and  kindliness  are  contagious,  so,  unfortunately,  are 
moroseness,  acerbity,  churlishness  and  ill-will  and  the  latter  are 
mental  states  which  are  most  harmful  to  the  nervous  system.  It 
is  entirely  possible,  with  long  training,  practically  to  banish  anger, 
worry,  irritability  and  uncharitableness  from  one's  life.  You  will 
be  impressed  with  a  passage  in  Arnold  Bennett's  book  The  Human 
Machine  (9)  which  deals  with  the  matter  of  blaming,  of  judging 
others,  and  emitting  verdicts  upon  them.  You  may  not  agree  with 
him  but  he  will  make  you  think,  at  least,  when  he  says:  "All 
blame,  uttered  or  unexpressed,  is  wrong.  I  do  not  blame  myself. 
I  can  explain  myself  to  myself.  I  can  invariably  explain  myself. 
If  I  forged  a  friend's  name  on  a  cheque  I  should  explain  the  affair 
quite  satisfactorily  to  myself.  And  instead  of  blaming  myself  I 
should  sympathize  with  myself  for  having  been  driven  into  such 
an  excessively  awkward  corner.  Let  me  examine  honestly  my 
mental  processes,  and  I  must  admit  that  my  attitude  towards 
others  is  entirely  different  from  my  attitude  towards  myself.  I 
must  admit  that  in  the  seclusion  of  my  mind,  though  I  say  not  a 
word,  I  am  constantly  blaming  others  because  I  am  not  happy. 
Whenever  I  bump  up  against  an  opposing  personality  and  my 


MENTAL  HYGIENE  9 

smooth  progress  is  impeded,  I  secretly  blame  the  opposer.  I  act 
as  though  I  had  shouted  to  the  world:  "Clear  out  of  the  way, 
everyone,  for  I  am  coming!'  Everyone  does  not  clear  out  of  the 
way.  I  did  not  really  expect  everyone  to  clear  out  of  the  way. 
But  I  act,  within,  as  though  I  had  so  expected.  I  blame.  Hence 
kindliness,  hence  cheerfulness,  is  rendered  vastly  more  difficult 
for  me. 

"What  I  ought  to  do  is  this !  I  ought  to  reflect  again  and  again, 
and  yet  again,  that  the  beings  among  whom  I  have  to  steer,  the 
living  environment  out  of  which  I  have  to  manufacture  my 
happiness,  are  just  as  inevitable  in  the  scheme  of  evolution;  as  I 
am  myself ;  have  just  as  much  right  to  be  themselves  as  I  have  to 
be  myself;  are  precisely  my  equals  in  the  face  of  Nature;  are 
capable  of  being  explained  as  I  am  capable  of  being  explained; 
are  entitled  to  the  same  latitude  as  I  am  entitled  to,  and  are  no 
more  responsible  for  their  composition  and  their  environment  than 
I  for  mine.  I  ought  to  reflect  again  and  again,  and  yet  again,  that 
they  all  deserve  from  me  as  much  sympathy  as  I  give  to  myself. 
Why  not  ?  Having  thus  reflected  in  a  general  manner,  I  ought  to 
take  one  by  one  the  individuals  with  whom  I  am  brought  into 
frequent  contact,  and  seek,  by  a  deliberate  effort  of  the  imagina- 
tion and  the  reason,  to  understand  them,  to  understand  why  they 
act  thus  and  thus,  what  their  difficulties  are,  what  their 
explanation  is,  and  how  friction  can  be  avoided.  So  I  ought  to 
reflect,  morning  after  morning,  until  my  brain  is  saturated  with 
the  cases  of  these  individuals.  Here  is  a  course  of  discipline.  If 
I  follow  it  I  shall  gradually  lose  the  preposterous  habit  of  blaming, 
and  I  shall  have  laid  the  foundations  of  that  quiet,  unshakable 
self-possession  which  is  the  indispensable  preliminary  of  conduct 
according  to  reason,  of  thorough  efficiency  in  the  machine  of 
happiness." 

The  growing  child  will  nearly  always  find  himself  confronted 
by  a  sufficient  number  of  disagreeable  excitations  to  give  him 
opportunity  for  the  cultivation  of  emotional  control.  It  is  not 
desirable  that  life  should  be  arranged  otherwise  for  him ;  it  would 
be  far  from  advantageous  to  him  to  be  protected  from  everything 
tending  to  stir  his  feelings  and  emotions.  Attempts  to  follow  the 


io  MENTAL  HYGIENE 

founder  of  Buddhism  in  the  idea  of  educating  youth  by  suppress- 
ing desire  and  keeping  the  individual  from  the  sight  of  suffering, 
care  or  sorrow,  would  lead  to  a  race  of  weaklings  insufficient  for 
the  struggle  of  life.  Far  better,  as  Ziehen  (io)  and  Oppenheim 
recommend,  purposely  to  expose  the  neuropathic  child  occa- 
sionally to  opportunity  for  slight  emotional  outbreak  in  order  that 
he  may  by  a  sort  of  "gymnastic"  of  the  emotions  gradually  learn 
to  be  master  of  himself. 

The  sensitive  nervous  system,  if  over-protected  in  the  early 
years,  suffers  keenly  when  later  on  the  principle  of  protection  has, 
perforce,  to  give  way  to  the  principle  of  exertion.  A  lady  of  great 
refinement,  who,  owing  to  an  illness  which  necessitated  hospital 
treatment,  was  unpreparedly  made  aware  of  the  world-pain  which 
exists  and  of  which  she  had  previously  known  but  little  owing  to 
her  mode  of  life,  once  told  me  how  the  sudden  contact  with 
suffering  humanity  affected  her.  "I  saw  and  heard  so  much  that 
distressed  me  that  all  life  seemed  to  be  an  open  wound.  ...  I 
used  to  lie  awake  all  night,  thinking  about  what  I  had  seen  or 
heard  or  suspected  during  the  day,  and  /  thought  I  should  go  mad 
because  I  could  do  nothing  to  stem  that  rising  tide  of  misery  and 
corruption."  Fortunately,  she  was  made  of  excellent  stuff  and  so 
profited  by  the  chastening  experience  that,  on  recovery,  she  joined 
a  group  of  enthusiastic  social  workers  and  now  labors  earnestly 
to  improve  human  conditions  in  the  city  and  state  in  which  she 
lives. 

Especial  care  should  be  exercised  to  prevent  disagreeable  feel- 
ings and  emotions  becoming  transformed  into  the  more  persistent 
moods.  It  is  often  better  for  an  emotion  to  discharge  itself  in 
the  form  of  some  definite  act  and  thus  bring  it  to  an  end  rather 
than  through  the  partial  suppression  of  it,  have  it  last  in  the  form 
of  a  disagreeable  mood,  for  a  considerable  length  of  time.  Pouting, 
sulkiness,  harboring  a  grudge,  or  bearing  malice,  should  be 
regarded  as  symptoms  seriously  to  be  considered  and  corrected, 
for  if  they  be  tolerated  in  the  child,  habits  may  be  begun  which 
will  prepare  the  soil  for  the  development,  later  in  life,  of  the 
seeds  of  enmity  and  suspicion;  the  full  grown  plants  are  the 
persecutory  ideas  of  the  paranoid  states. 


MENTAL  HYGIENE  1 1 

How  to  manage  a  child  in  a  fit  of  temper  has  been  much  dis- 
cussed. When  possible  it  is  desirable  to  cut  it  short  at  the 
beginning.  Some  parents  rejoice  to  see  their  children  reveal  a 
violent  temper,  and  are  glad  that  they  can  fly  into  a  passion,  turn 
red  as  a  beet,  clench  the  fists  and  attack  the  individual  with  whom 
they  are  angry.  Such  attacks  if  frequently  repeated  are  very 
deleterious  to  the  nervous  system.  Some  parents  try  to  stop  them 
by  petting  or  indulging  the  child,  a  kind  of  licensing  of  irritability 
which  rarely,  if  ever,  pays ;  others  threaten  the  child  or  corporally 
punish  him ;  a  mistake,  usually,  in  the  other  direction.  As  a  rule, 
most  may  be  accomplished  by  purpjosefully^igjioring  the  attack, 
perhaps  isolating  the  child  for  a  short  period;  in  some  cases  a 
warm  bath  and  the  bed  may  be  the  best  remedies!  In  older 
children  the  habit  of  giving  way  to  temper  may  sometimes  be 
broken  by  inculcating  the  conviction  that  one  who  loses  his  temper 
makes  a  fool  of  himself,  loses  his  dignity  and  excites  the  disdain 
and  contempt  of  his  fellows :  the  horror  of  looking  ridiculous,  of 
making  a  donkey  of  one's  self,  may  be  a  most  powerful  lever  in 
conquering  a  tendency  to  attacks  of  fury. 

All  children  are  easily  frightened,  but  the  child  predisposed  to 
nervousness,  more  easily  than  the  healthy  child,  becomes  the 
victim  of  abnormal  fears  or  timidity.  The  Italian  physiologist, 
Mosso,  writing  on  "fear"  (u)  once  said:  "Every  ugly  thing  told 
to  the  child,  every  shock,  every  fright  given  him,  will  remain  like 
a  minute  splinter  in  the  flesh,  to  torture  him  all  his  life  long."  In 
Greece  and  Rome  the  children  were  frightened  with  the  lamias 
or  female  demons  who  would  charm  them  and  suck  their  blood, 
with  the  one-eyed  Cyclops  or  with  a  black  god,  Mercury,  who 
would  come  to  carry  them  away.  And  this  very  pernicious  error 
in  education  still  prevails.  The  mother,  the  nurse,  the  maid  and 
the  servants  still  frighten  the  child  with  tales  of  the  bogey-man, 
of  goblins,  or  ogres,  of  wizards  and  of  witches.  How  often  is  a 
child  frightened  to  tears,  its  disposition  spoiled  and  its  life  made  a 
burden  by  tales,  threats  or  tortures  which  make  it  timid  and 
shrinking;  sometimes  fears  are  thus  started  which  last  through 
life.  One  must  learn  how  to  deal  with  the  fear  of  being  alone,  the 
fear  of  the  dark  and  the  fear  of  thunder  and  lightning.  Certain 


12  MENTAL  HYGIENE 

fears,   common   to   childhood,   are   easily   overcome,    especially 
through  the  example  of  courage  set  by  parent,  nurse  or  teacher. 

In  some  instances,  however,  the  fears  are  a  symptom  of  disease 
and  when  there  is  doubt  a  physician  should  always  be  consulted. 
A  young  girl,  recently  brought  to  me,  because  of  an  unaccountable, 
persistent,  and  distressing  fear  of  "burglars  in  the  house,"  was 
found  to  be  suffering  from  exophthalmic  goitre ;  on  removal  of  a 
portion  of  the  thyroid  gland  by  Dr.  Halsted  the  child  rapidly 
improved  and  on  last  report  was  only  occasionally  troubled  by  the 
fear ;  it  seems  probable  that  she  will  soon  be  entirely  free  from  it. 
Children  who  suffer  from  "night  terrors"  often  have  adenoid 
growths  in  the  nasopharynx ;  on  removal  of  the  growth  by  a  slight 
operation  the  "night  terrors"  disappear. 

In  his  book  (12)  entitled  The  Natural  Way  in  Moral  Training, 
Patterson  DuBois  emphasizes  the  importance  of  what  he  calls 
"nurture  by  atmosphere"  by  which  he  means  the  indirect  educa- 
tion of  the  feelings  and  John  Dewey   (13)   asserts  that  "The 
C  feelings  and  sentiments  are  the  most  sacred  and  mysterious  part 
.    of  the  individual,  and  should  always  be  approached  and  'influenced 
;  indirectly :'  "    More  can  be  accomplished  by  the  setting  of  a  good 
example  in  enthusiasms,  depreciations,  reverence,  and  admirations 
than  by  direct  preaching. 

Let  no  one  think,  however,  that  lack  of  feeling,  or  a  nature 
impoverished  on  the  emotional  side  is  desirable  or  that  it  protects 
against  nervous  disease.  The  elevating  emotions,  hope,  joy,  ex- 
pectation, love — are  constructive  and  are  judiciously  to  be  culti- 
vated; the  depressing  emotions — despair,  sorrow,  regret  and  fear 
— are  damaging  to  the  nervous  system  if  long  maintained.  The 
highest  feelings  of  all,  including  the  religious,  the  ethical  and  the 
aesthetic — inspire  noble  and  useful  conduct  and  in  the  education 
of  nervous  children  these  sentiments  are  to  be  favored  in  their 
development,  in  due  degree,  at  a  suitable  age. 

It  is  a  serious  mistake  to  lead  the  young  child  into  experiences 
that  belong  properly  to  a  later  age.  When  children  under  ten 
years  of  age  are  made  to  travel  extensively,  to  visit  museums  and 
picture  galleries,  to  attend  the  theatre  and  the  opera,  they  are 
introduced  to  entertainment  wholly  unsuited  to  their  time  of  life 


MENTAL  HYGIENE  13 

and  which  they,  in  their  immaturity,  are  entirely  unfitted  to  enjoy. 
Later  on  at  an  age  when  they  should  learn  to  know  such  things 
for  the  first  time  the  attractiveness  of  novelty  is  wanting;  they 
are  cheated  of  the  pleasures  which  normally  should  be  theirs.  As 
Oppenheim  well  puts  it,  a  "child's  childishness  is  its  greatest 
asset." 

On  the  training  of  the  religious,  ethical  and  aesthetic  feelings 
time  will  not  permit  me  to  speak,  though  I  regard  the  topics  of 
the  greatest  importance  for  the  health  of  the  nervous  system. 
Certainly  the  cultivation  of  the  love  of  nature,  of  truth,  of  good- 
ness, of  beauty,  and  of  humanity  cannot  help  but  strengthen  the 
character  and  the  will.  The  altruistic  feelings,  when  they  begin 
to  appear,  should  be  given  opportunity  for  expression. 

Above  all  as  a  factor  making  for  the  health  of  the  nervous 
system  the  joy  of  work  (14)  must  be  referred  to.  It  is  one  of 
the  greatest  pleasures  life  offers ;  moreover  it  compels  concentra- 
tion of  attention,  and  protects  from  all  the  dangers  which  attend 
upon  idleness.  "Education  to  idleness  is  education  to  nervous- 
ness." Overwork  must  be  avoided;  neither  bodily  or  mental 
fatigue  should  be  permitted  in  excess.  Regular,  systematic,  en- 
joyable work,  suited  to  the  interests  and  powers  of  the  worker, 
is  the  best  tonic  I  know  of.  If  the  work  can  be  in  the  country, 
rather  than  in  the  city,  all  the  better,  especially  for  those  with 
nervous  predisposition.  The  enjoyment  of  nature  possible  in  the 
country,  the  opportunities  for  work  in  wood,  field  or  garden  and 
upon  the  river,  keeping  the  worker  much  in  the  open  air,  exercis- 
ing his  muscles,  drawing  his  attention  away  from  himself  and 
fixing  it  upon  things  outside — what  conditions  could  be  more 
favorable  to  the  health  and  happiness  of  the  nervous  child.  If  the 
nervous  children  that  we  see  in  towns  could  be  transplanted  to 
villages  and  the  country — away  from  the  din  and  bustle  of  the 
city,  its  restlessness,  its  haste  and  its  feverish  excitements,  what 
a  host  of  advantages  would>accrue !  The  schools  are  growing  ever 
better  in  the  country;  in  many  country  districts  they  are  now 
excellent.  The  movement  which  began  with  the  New  School  of 
Dr.  Cecil  Reddie  (15)  in  Abbotsholme,  England,  and  which  has 
led  to  the  Landerzichungsheime  of  Lietz  (16)  in  the  Harz  and 


14  MENTAL  HYGIENE 

in  Thuringen  and  of  Triiper  (17)  near  Jena  should  be  followed 
and  imitated  in  this  country. 

In  any  case  nervous  children  should  not  be  sent  to  school  too 
early;  preferably  they  should  start  a  year  or  even  several  years 
later  than  the  normal  child.  And  in  the  schools  they  should  never 
be  pushed  ahead  too  fast;  competition  is  dangerous  for  the 
nervous  child.  The  mistaken  ambition  of  parents  who  desire  their 
children  to  head  the  class  is  often  responsible  for  serious  injury 
to  health. 

Sleeplessness  is  always  a  danger  signal.  In  children  it  is  most 
often  due  to  indigestion  or  to  mental  overstrain;  occasionally  to 
premature  sexual  excitations.  If  insomnia  appear  and  especially 
if  it  persist,  the  parents  should  consult  a  physician. 

Medicine,  psychology  and  pedagogy  are  all  concerned  in  solving 
the  problem  presented  by  the  nervous  child.  These  sciences  have 
already  made  great  conquests;  what  the  future  may  hold  for 
them,  who  will  attempt  to  foretell  ?  Let  us  avail  ourselves  of  the 
knowledge  we  have,  doing  what  we  can  to  dispel  the  scepticism  of 
the  ignorant  and  at  the  same  time  avoiding  the  futile  enthusiasm 
of  those  who  believe  they  know  all. 


REFERENCES. 

(1)  OPPENHEIM  (H.)     Nervenleiden  und  Erziehung.  Berlin, 
1899. 

(2)  HOLT  (L.  E.)     The  Care  and  Feeding  of  Children,  4th 
ed.    D.  Appleton  &  Co.,  New  York. 

(3)  STARR  (L.)     Hygiene  of  the  Nursery,  4th  ed.    P.  Blakis- 
ton's  Son  &  Co.,  Philadelphia. 

(4)  GRIFFITH  (J.  P.  C.)     The  Care  of  the  Baby,  2nd  ed.     W. 
B.  Saunders,  Philadelphia. 

(5)  MULLER  (J.  P.)     My  System;  Fifteen  Minutes'  Work  a 
Day  for  Health's  Sake.     English  Translation  by  G.  M.  Fox- 
Davies,  New  York,   1905.     The  Anglo-Danish  Publishing  Co., 
New  York. 

(6)  GULICK  (L.  H.)     Ten  Minutes  Exercise  for  Busy  Men. 
New  York. 


MENTAL  HYGIENE  15 

(7)  MACKENZIE  (R.  T.)     Exercise  in  Education  and  Medi- 
cine.   W.  B.  Saunders,  Philadelphia. 

(8)  LAGRANGE  (F.)    Physiology  of  Bodily  Exercise.    Trench 
&   Co.,    London.     Also,   Les   Mouvements   methodiques   et   la 
"mecanotherapie"    F.  Alcan,  Paris,  France. 

(9)  BENNETT  (A.)    The  Human  Machine.    George  H.  Doran 
Co.,  New  York. 

(10)  ZIEHEN  (T.)  Hysteria  und  Neurasthenie.  Article  in 
Eulenburg's  Real-Encyclopadie. 

(u)  Mosso  (A.)  Fear.  English  Translation  by  E.  Lough 
and  F.  Kiesow.  Longmans,  Green  &  Co.,  New  York. 

(12)  Du  Bois  (P.)     The  Natural  Way  in  Moral  Training. 
Four  Modes  of  Nurture.    Fleming  H.  Revell  &  Co.,  New  York. 

(13)  DEWEY  (J.)     Educational  Creeds. 

(14)  GROHMANN    (A.)    Technisches  und  Psychologisches  in 
der  Beschdftigung  von  Nervenkranken.    Stuttgart,  1899. 

(15)  REDDIE  (C.)    Abbotsholme.   Rep.  Roy.  Com.  on  Second- 
ary Education.     1894.    Also,  his  book — Abbotsholme  1889-1899, 
or  ten  years  work  in  an  Educational  Laboratory.    London,  1900. 

(16)  LIETZ  (H.)  Emlohstobba.  Bilder  aus  dem  Schulleben 
der  Vergangenheit,  Gegenwart  oder  Zukunft.  Berlin,  1897.  See 
also  W.  Frei's  Lander siehungsheime,  Leipzig,  1902. 

(17)  TRUPER  (J.)  Das  Ersiehungsheim  und  Jugendsanator- 
ium  auf  der  Sophienhohe  bei  Jena.  Langensolza.  1910. 


The  Connecticut  Society  for  Mental  Hygiene 

PRESIDENT,  DR.  GEORGE  BLUMER 
VICE-PRESIDENTS,  HON.  COSTELLO  L1PPITT.  HON.  FRANK  B.  WEEKS 

TREASURER  MR.  VICTOR  MORRIS  TYLER 
CHAIRMAN  OF  EXECUTIVE  COMMITTEE,  DR.  HENRY  S.  NOBLE 


MR.  CLIFFORD  W.  BEERS,  EXECUTIVE  SECRETARY 
MISS  JESSIE  I.  BELYEA,  FIELD  SECRETARY 


Kinds  of  Advice  and  Assistance  given  by  the  Social 

Service  Department  of  The  Connecticut 

Society  for  Mental  Hygiene. 

1.  Advice  and  assistance  to  individuals  who  fear  nervous  or 
mental  collapse,  with  a  view  to  causing  them  to  seek  treatment 
promptly. 

2.  Advice  and  assistance  to  relatives  and  friends  of  patients 
suffering  from  nervous  or  mental  disorders,  whether  under  treat- 
ment in  their  own  homes  or  in  public  or  private  hospitals. 

3.  Information  regarding  public  and  private  hospitals  in  which 
cases  of  nervous  and  mental  disorder  are  treated. 

4.  Advice  regarding  commitment  to  hospitals,  viz.,   methods 
of  procedure,  the  mental  examination  of  the  patient,  voluntary  com- 
mitment, commitment  by  Judges  of  Probate,  cost,  etc. 

5.  Advice  regarding  the  management  of  the  patient  pending 
commitment  with  a  view  to  avoiding  harmful  mismanagement  at 
this  critical  period. 

6.  Advice  regarding  the  best  methods  of  transfering  the  patient 
from  his  home  to  the  hospital. 

7.  Advice,  and  assistance  when  necessary,  for  the  family  of  the 
patient  while  he  is  in  the  hospital,  supplementing  the  advice  of  the 
hospital  physicians  who  collaborate    with    the    Society's    social 
workers. 

8.  AFTER  CARE.    Advice  and  assistance  to  discharged  patients 
(and  those  who  recover  at  home),  not  only  at  the  time  of  their 
recovery,  but  indefinitely  if  necessary,  with  a  view  to  preventing 
relapse,  and  also  in  order  that  they  may  the  more  easily  re-establish 
themselves  in  society  and  again  become  self-supporting. 

9.  ADVICE  FOR  EVERYBODY.    Verbal  and  printed  advice 
for  those  who  desire  information  regarding  the  avoidable  causes 
of  mental  disorder  and  the  general  principles  of  mental  hygiene. 

All  correspondence  should  be  addressed  to  Miss 
Jessie  I.  Belyea,  Field  Secretary,  or  to  Clifford  W.  Beers, 
Executive  Secretary,  Room  318,  No.  39  Church  Street, 
New  Haven,  Connecticut. 

Interviews  may  be  arranged  by  telephone :  Call  3008, 
New  Haven. 


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